IN less than two years after the move to Richmond Philip Morris USA has again won the title of “Asthma Capital” of the U.S. for the second year in a row. The Asthma and Allergy Foundation of America also ranked Virginia Beach in the top 10 most challenging places to live with asthma.

The group's rankings are based on scoring of a variety of factors in the 100 largest U.S. metropolitan areas. The foundation has conducted the study for eight years.

Richmond ranked 14th in 2009, but jumped to the top spot last year. The group says Richmond's ranking is based on factors including a higher than average pollen score, continued poor air quality, a lack of public smoking bans, and high poverty and uninsured rates.

Does the production of million of cigarettes results in continued poor air quality??

“Although Richmond is a particularly difficult place for people with asthma to live, asthma triggers are present in every American city,” Mike Tringale, a spokesman with the group said in a news release. “There is no way for asthma patients to escape their disease, but no matter where they live, patients can work with their physicians to find ways to control their symptoms better.”

Asthma is characterized by inflammation of the lungs resulting in chronic wheezing, coughing and difficulty breathing. It causes more than 4,000 deaths annually and more than 500,000 hospitalizations, as well as $18 billion in medical expenses and indirect costs each year.